Hospitals in the United States provide the setting for some of life's most pivotal events - the birth of a child, major surgery, treatment for otherwise fatal illnesses. These hospitals house the most sophisticated medical technology in the world and provide state-of-the-art diagnostic and therapeutic services. But access to these services comes with certain costs. About 30% of personal health care expenditures in the United States go towards hospital care, and the rate of growth in spending for hospital services has only recently leveled out after several years of increases following a half a decade of declining growth. Simultaneously, concerns about the quality of health care services have reached a crescendo with the Institute of Medicine's series of reports describing the problem of medical errors and the need for a complete restructuring of the health care system to improve the quality of care. Policymakers, employers, and consumers have made the quality of care in U.S. hospitals a top priority and have voiced the need to assess, monitor, track, and improve the quality of inpatient care.
Widespread consensus exists that health care organizations can reduce patient injuries by improving the environment for safety from implementing technical changes, such as electronic medical record systems, to improving staff awareness of patient safety risks. Clinical process interventions also have strong evidence for reducing the risk of adverse events related to a patient's exposure to hospital care. Patient Safety Indicators (PSIs), which are based on computerized hospital discharge abstracts from the AHRQ's Healthcare Cost and Utilization Project (HCUP), can be used to better prioritize and evaluate local and national initiatives. Analyses of these and similar inexpensive, readily available administrative data sets may provide a screen for potential medical errors and a method for monitoring trends over time.
The Complications of Anesthesia indicator* is intended to capture cases flagged by external cause-of-injury codes (e-codes) and complications codes for adverse effects from the administration of therapeutic drugs, as well as the overdose of anesthetic agents used primarily in therapeutic settings.
*The following concerns affect the validity of this indicator:
- Condition definition varies: This indicator includes conditions for which diagnosis may be subjective, depending on the threshold of the physician, and patients with the same clinical state may not have the same diagnosis.
- Underreporting or screening: Conditions included in this indicator may not be systematically reported (leading to an artificially low rate) or may be routinely screened for (leading to a higher rate in facilities that screen).
- Denominator unspecific: The denominator for this indicator is less than ideal, because the true population at risk could not be identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Some patients are likely included who are not truly at risk, or some patients who are at risk are not included.
Refer to the original measure documentation for further information.
